Psychometric properties of loaded and unloaded timed stair tests in assessing people with knee osteoarthritis.

Psychosis is characterized by strongly held unusual beliefs and often distressing sensory experiences, such as hearing voices [], and can cause difficulties in many aspects of life, including interpersonal relationships, reduced quality of life, and increased risk of early death due to poorer health outcomes []. In the United Kingdom, clinical practice guidelines recommend psychological interventions, such as cognitive behavioral therapy or family interventions, for individuals with psychosis []. However, access to these therapies remains below recommended levels [,]. Given these persistent access challenges, attention has increasingly turned to digital mental health interventions (DMHIs), or technology-based treatment designed to improve users’ mental health [], as a potential way to expand psychological support. Notably, a 2024 early value assessment by the National Institute for Health and Care Excellence in the United Kingdom highlighted DMHIs could be a promising treatment mode for those with psychosis []. Although evidence suggests DMHIs can reduce mental health symptoms experienced by those with psychosis [,], implementing these interventions in practice remains a persistent challenge [-]. To help bridge this DMHI evidence-practice gap, an international commission from Lancet Psychiatry in 2024 recommended adopting methods that embed implementation work throughout the research process []. One such research method is a process evaluation, or studies that are often embedded in randomized controlled trials (RCTs) that explore how, for whom, and where interventions work []. The most recent process evaluation guidance was published by the Medical Research Council (MRC) in the United Kingdom in 2015 []. Process evaluation in the MRC framework explores 3 outcomes () [].